Summary It is recognized that populations in low middle income countries in South Asia undergoing economic development also transition in their disease risks and outcomes towards a dominant burden of non- communicable disease (NCD) with the major contribution from metabolic and cardiovascular disease (M/CVD). However, there is a gap in locally relevant knowledge about changing needs, risk factors and their impacts, and culturally appropriate and effective state-of-the-science prevention strategies are lacking. We will address this gap by assessing needs, building capacity and conducting foundational explorative research in a collaborative effort with the International Center for Diarrhea Disease Research, Bangladesh (icddr,b). We propose a pilot study leveraging an existing birth cohort in Matlab, Bangladesh, with detailed surveillance and follow up data available since pregnancy, including data on growth, development, environ- mental exposures, infections, and socioeconomic status. Nested into the birth cohort, we will enroll a pilot group aged 14-15 years at the time of study and characterize their M/CVD ?risk profiles? focusing locally relevant environmental factors (arsenic, biomass use), dietary patterns, and the use of tobacco, mobile communication technology, physical activity, and other relevant behaviors. We will further assess early markers of metabolic and cardiovascular disease (anthropometry, lipids, glucose, blood pressure), and link the newly collected data with the existing data of participant's life trajectories, including data since pregnancy (weight, growth, nutrition, infections, SES, etc.) and conduct exploratory analysis appropriate to the nature of the pilot study. With regards to preventive measures, we will carry out formative research using participatory and culturally sensitive methods. We will further test the feasibility of using new mobile technologies, including mobile and wearable devices, in terms of risk factor assessment and monitoring, outcome assessment, and development of interventions approaches that use the means of mobile technology (e.g. for feedback). Capacity building to address M/CVDs is integral to this proposal throughout each step by close collaboration in developing and carrying out the exploratory research, facilitating networking and fostering NCD related research efforts, as well as integrating local junior scientists. A major strength of the proposed study is that it forms the bases for a subsequent expanded study into which we plan to include the full original birth cohort of over 2,500 subjects with prospective data available. Overall this project is novel and highly efficiently leveraging resources in an income constraint setting and a unique timely opportunity to build onto our existing cohort. This project will strengthen the research capacity in combating the growing burden related to NCDs in low middle income countries especially in densely populated countries in South Asia with Bangladesh as a prime example, in an impactful manner. The longer term goal is to address M/CVD in a way that may serve as a model for similar countries in South Asia and contribute to the reduction of NCDs in these countries.